Tracing local and regional clusters of carbapenemase-producing Klebsiella pneumoniae ST512 with whole genome sequencing, Finland, 2013 to 2018

Janko van Beek; Kati Räisänen; Markku Broas; Jari Kauranen; Arja Kähkölä; Janne Laine; Eeva Mustonen; Tuija Nurkkala; Teija Puhto; Jaana Sinkkonen; Senja Torvinen; Tarja Vornanen; Risto Vuento; Jari Jalava; Outi Lyytikäinen

doi:10.2807/1560-7917.ES.2019.24.38.1800522

Tracing local and regional clusters of carbapenemase-producing Klebsiella pneumoniae ST512 with whole genome sequencing, Finland, 2013 to 2018

Janko van Beek
, Kati Räisänen
, Markku Broas
, Jari Kauranen
, Arja Kähkölä
, Janne Laine
, Eeva Mustonen
, Tuija Nurkkala
, Teija Puhto
, Jaana Sinkkonen
, Senja Torvinen
, Tarja Vornanen
, Risto Vuento
, Jari Jalava
, Outi Lyytikäinen^*

^*Corresponding author for this work

National Institute for Health and Welfare
Lapland Central Hospital
NordLab
Tampere University Hospital and Tampere University
Länsi-Pohja Central Hospital
Oulu University Hospital
Kainuu Central Hospital
Fimlab Laboratories
European Programme for Public Health Microbiology Training (EUPHEM)
European Centre for Disease Prevention and Control (ECDC)

Research output: Contribution to journal › Article › Academic › peer-review

21 Citations (Scopus)

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Abstract

Background: Two epidemiologically-unrelated clusters of Klebsiella pneumoniae carbapenemase (KPC)producing K. pneumoniae were detected among several healthcare facilities (HCF) in Finland by routine surveillance using whole genome sequencing (WGS). Aim: The objective was to investigate transmission chains to stop further spread of the responsible strain. Methods: In this observational retrospective study, cases were defined as patients with K. pneumoniae KPC-3sequence type (ST)512 strain detected in Finland from August 2013 to May 2018. Environmental specimens were obtained from surfaces, sinks and toilets in affected wards. WGS was performed on K. pneumoniae cultures using Illumina MiSeq platform and data were analysed using Ridom SeqShere software K. pneumoniae core genome multilocus sequence typing (cgMLST) scheme. Epidemiological information of the cases was provided by HCFs. Results: We identified 20 cases in six HCFs: cluster1 included 18 cases in five HCFs and cluster2 two cases in one HCF. In cluster1, a link with a foreign country was unclear, 6/18 cases without overlapping stay had occupied the same room in one of the five HCFs within>3years. In cluster2, the index case was transferred from abroad, both cases occupied the same room 8months apart. A strain identical to that of the two cases in cgMLST was isolated from the toilet of the room, suggesting a clonal origin. Conclusions: The clusters were mostly related to case transfer between facilities and likely involved environmental transmission. We show that CPE surveillance using WGS and collaboration between hospitals are crucial to identify clusters and trace transmission chains.

Original language	English
Article number	1800522
Journal	Eurosurveillance
Volume	24
Issue number	38
DOIs	https://doi.org/10.2807/1560-7917.ES.2019.24.38.1800522
Publication status	Published - 19 Sept 2019
Externally published	Yes

Bibliographical note

Funding Information:
This work was a team effort and we would like to acknowledge all people involved in the laboratory and epidemiological investigations. We would like to thank Ulla Kaukoniemi, infectious disease specialist, Länsi-Pohja Central Hospital, Finland, for support with the outbreak investigation. The authors wish to acknowledge CSC - IT Center for Science, Finland, for providing computational resources.

Publisher Copyright:
© 2019 European Centre for Disease Prevention and Control (ECDC). All rights reserved.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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Tracing local and regional clusters of carbapenemase-producing Klebsiella pneumoniae ST512 with whole genome sequencing, Finland, 2013 to 2018Final published version, 302 KBLicence: CC BY

Cite this

van Beek, J., Räisänen, K., Broas, M., Kauranen, J., Kähkölä, A., Laine, J., Mustonen, E., Nurkkala, T., Puhto, T., Sinkkonen, J., Torvinen, S., Vornanen, T., Vuento, R., Jalava, J., & Lyytikäinen, O. (2019). Tracing local and regional clusters of carbapenemase-producing Klebsiella pneumoniae ST512 with whole genome sequencing, Finland, 2013 to 2018. Eurosurveillance, 24(38), Article 1800522. https://doi.org/10.2807/1560-7917.ES.2019.24.38.1800522

@article{16a12d450a3242d2a4f6e66ec2727005,

title = "Tracing local and regional clusters of carbapenemase-producing Klebsiella pneumoniae ST512 with whole genome sequencing, Finland, 2013 to 2018",

abstract = "Background: Two epidemiologically-unrelated clusters of Klebsiella pneumoniae carbapenemase (KPC)producing K. pneumoniae were detected among several healthcare facilities (HCF) in Finland by routine surveillance using whole genome sequencing (WGS). Aim: The objective was to investigate transmission chains to stop further spread of the responsible strain. Methods: In this observational retrospective study, cases were defined as patients with K. pneumoniae KPC-3sequence type (ST)512 strain detected in Finland from August 2013 to May 2018. Environmental specimens were obtained from surfaces, sinks and toilets in affected wards. WGS was performed on K. pneumoniae cultures using Illumina MiSeq platform and data were analysed using Ridom SeqShere software K. pneumoniae core genome multilocus sequence typing (cgMLST) scheme. Epidemiological information of the cases was provided by HCFs. Results: We identified 20 cases in six HCFs: cluster1 included 18 cases in five HCFs and cluster2 two cases in one HCF. In cluster1, a link with a foreign country was unclear, 6/18 cases without overlapping stay had occupied the same room in one of the five HCFs within>3years. In cluster2, the index case was transferred from abroad, both cases occupied the same room 8months apart. A strain identical to that of the two cases in cgMLST was isolated from the toilet of the room, suggesting a clonal origin. Conclusions: The clusters were mostly related to case transfer between facilities and likely involved environmental transmission. We show that CPE surveillance using WGS and collaboration between hospitals are crucial to identify clusters and trace transmission chains.",

author = "\{van Beek\}, Janko and Kati R{\"a}is{\"a}nen and Markku Broas and Jari Kauranen and Arja K{\"a}hk{\"o}l{\"a} and Janne Laine and Eeva Mustonen and Tuija Nurkkala and Teija Puhto and Jaana Sinkkonen and Senja Torvinen and Tarja Vornanen and Risto Vuento and Jari Jalava and Outi Lyytik{\"a}inen",

note = "Funding Information: This work was a team effort and we would like to acknowledge all people involved in the laboratory and epidemiological investigations. We would like to thank Ulla Kaukoniemi, infectious disease specialist, L{\"a}nsi-Pohja Central Hospital, Finland, for support with the outbreak investigation. The authors wish to acknowledge CSC - IT Center for Science, Finland, for providing computational resources. Publisher Copyright: {\textcopyright} 2019 European Centre for Disease Prevention and Control (ECDC). All rights reserved.",

year = "2019",

month = sep,

day = "19",

doi = "10.2807/1560-7917.ES.2019.24.38.1800522",

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journal = "Eurosurveillance",

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publisher = "European Centre for Disease Prevention and Control (ECDC)",

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van Beek, J, Räisänen, K, Broas, M, Kauranen, J, Kähkölä, A, Laine, J, Mustonen, E, Nurkkala, T, Puhto, T, Sinkkonen, J, Torvinen, S, Vornanen, T, Vuento, R, Jalava, J & Lyytikäinen, O 2019, 'Tracing local and regional clusters of carbapenemase-producing Klebsiella pneumoniae ST512 with whole genome sequencing, Finland, 2013 to 2018', Eurosurveillance, vol. 24, no. 38, 1800522. https://doi.org/10.2807/1560-7917.ES.2019.24.38.1800522

TY - JOUR

T1 - Tracing local and regional clusters of carbapenemase-producing Klebsiella pneumoniae ST512 with whole genome sequencing, Finland, 2013 to 2018

AU - van Beek, Janko

AU - Räisänen, Kati

AU - Broas, Markku

AU - Kauranen, Jari

AU - Kähkölä, Arja

AU - Laine, Janne

AU - Mustonen, Eeva

AU - Nurkkala, Tuija

AU - Puhto, Teija

AU - Sinkkonen, Jaana

AU - Torvinen, Senja

AU - Vornanen, Tarja

AU - Vuento, Risto

AU - Jalava, Jari

AU - Lyytikäinen, Outi

N1 - Funding Information: This work was a team effort and we would like to acknowledge all people involved in the laboratory and epidemiological investigations. We would like to thank Ulla Kaukoniemi, infectious disease specialist, Länsi-Pohja Central Hospital, Finland, for support with the outbreak investigation. The authors wish to acknowledge CSC - IT Center for Science, Finland, for providing computational resources. Publisher Copyright: © 2019 European Centre for Disease Prevention and Control (ECDC). All rights reserved.

PY - 2019/9/19

Y1 - 2019/9/19

N2 - Background: Two epidemiologically-unrelated clusters of Klebsiella pneumoniae carbapenemase (KPC)producing K. pneumoniae were detected among several healthcare facilities (HCF) in Finland by routine surveillance using whole genome sequencing (WGS). Aim: The objective was to investigate transmission chains to stop further spread of the responsible strain. Methods: In this observational retrospective study, cases were defined as patients with K. pneumoniae KPC-3sequence type (ST)512 strain detected in Finland from August 2013 to May 2018. Environmental specimens were obtained from surfaces, sinks and toilets in affected wards. WGS was performed on K. pneumoniae cultures using Illumina MiSeq platform and data were analysed using Ridom SeqShere software K. pneumoniae core genome multilocus sequence typing (cgMLST) scheme. Epidemiological information of the cases was provided by HCFs. Results: We identified 20 cases in six HCFs: cluster1 included 18 cases in five HCFs and cluster2 two cases in one HCF. In cluster1, a link with a foreign country was unclear, 6/18 cases without overlapping stay had occupied the same room in one of the five HCFs within>3years. In cluster2, the index case was transferred from abroad, both cases occupied the same room 8months apart. A strain identical to that of the two cases in cgMLST was isolated from the toilet of the room, suggesting a clonal origin. Conclusions: The clusters were mostly related to case transfer between facilities and likely involved environmental transmission. We show that CPE surveillance using WGS and collaboration between hospitals are crucial to identify clusters and trace transmission chains.

AB - Background: Two epidemiologically-unrelated clusters of Klebsiella pneumoniae carbapenemase (KPC)producing K. pneumoniae were detected among several healthcare facilities (HCF) in Finland by routine surveillance using whole genome sequencing (WGS). Aim: The objective was to investigate transmission chains to stop further spread of the responsible strain. Methods: In this observational retrospective study, cases were defined as patients with K. pneumoniae KPC-3sequence type (ST)512 strain detected in Finland from August 2013 to May 2018. Environmental specimens were obtained from surfaces, sinks and toilets in affected wards. WGS was performed on K. pneumoniae cultures using Illumina MiSeq platform and data were analysed using Ridom SeqShere software K. pneumoniae core genome multilocus sequence typing (cgMLST) scheme. Epidemiological information of the cases was provided by HCFs. Results: We identified 20 cases in six HCFs: cluster1 included 18 cases in five HCFs and cluster2 two cases in one HCF. In cluster1, a link with a foreign country was unclear, 6/18 cases without overlapping stay had occupied the same room in one of the five HCFs within>3years. In cluster2, the index case was transferred from abroad, both cases occupied the same room 8months apart. A strain identical to that of the two cases in cgMLST was isolated from the toilet of the room, suggesting a clonal origin. Conclusions: The clusters were mostly related to case transfer between facilities and likely involved environmental transmission. We show that CPE surveillance using WGS and collaboration between hospitals are crucial to identify clusters and trace transmission chains.

UR - https://www.scopus.com/pages/publications/85072610145

U2 - 10.2807/1560-7917.ES.2019.24.38.1800522

DO - 10.2807/1560-7917.ES.2019.24.38.1800522

M3 - Article

C2 - 31552821

AN - SCOPUS:85072610145

SN - 1025-496X

VL - 24

JO - Eurosurveillance

JF - Eurosurveillance

IS - 38

M1 - 1800522

ER -

Tracing local and regional clusters of carbapenemase-producing Klebsiella pneumoniae ST512 with whole genome sequencing, Finland, 2013 to 2018

Abstract

Bibliographical note

UN SDGs

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